Find out what Australian researchers are publishing in palliative care 

The following lists palliative care research primarily conducted by Australian research groups. The list is based on application of the CareSearch search filter for palliative care to identify articles held within the PubMed database and corresponding to the strongest evidence. Articles have been selected based on relevance and new articles are added on a weekly basis.

Whilst not an exhaustive list, the aim is to keep the community informed by providing a snapshot of recent research findings and planned studies in the Australian setting.

18 March 2024

Development of a palliative paramedicine framework to standardise best practice: A Delphi study.

Juhrmann ML, Butow PN, Simpson P, Boughey M, Makeham M, Clayton JM.

Abstract

Background: Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels.

Aim: To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia.

Design: Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken.

Setting/participants: Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine.

Results: Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework.

Conclusion: This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice.

18 March 2024

Quantifying the need for specialist palliative care management in systemic sclerosis.

Ross L, McDonald J, Hansen D, Fairley J, Wicks C, Proudman S, Walker J, Sahhar J, Ngian GS, Host L, Stevens W, Philip J, Nikpour M

Abstract

Objective: The importance of early integration of palliative care in the management of complex multi-system diseases has been recognised. In this study, we aimed to quantify the need for specialist palliative care in systemic sclerosis (SSc).

Methods: Using data from 875 patients enrolled in the Australian Scleroderma Cohort Study, we defined need for palliative care as a high symptom burden at ≥2 consecutive study visits, ≥50% of overall study visits or at the study visit immediately prior to death. Symptoms of interest included breathlessness, fatigue, pain, depression, anxiety, constipation, and diarrhoea. Logistic regression analyses evaluated the association between individual symptoms and SSc manifestations. Linear regression analysis evaluated the relationship between palliative care needs and quality of life (QoL) and function.

Results: Almost three-quarters (72.69%) of patients met the threshold for specialist palliative care needs. Severe fatigue (54.17%) was most common, followed by breathlessness (23.66%) and severe constipation (21.14%). Concurrent severe symptoms were frequently observed. Severe breathlessness (coef -7.95, p<0.01) and pain (coef -7.70, p<0.01) were associated with the largest reductions in physical QoL. Severe mood symptoms were associated with the greatest reduction in mental QoL (coef -12.91, p<0.01). Severe pain (coef 0.56, p<0.01), breathlessness (coef 0.49, p<0.01) and mood symptoms (coef 0.40, p<0.01) had a significant impact on function.

Conclusion: SSc is frequently associated with multiple severe symptoms that may be amenable to palliative care intervention. Given the strong association between symptom burden and impaired QoL targeted, effective symptom management in parallel with standard-of-care treatments may improve overall patient outcomes.

This article is protected by copyright. All rights reserved.

18 March 2024

Development and implementation of the Specialist Palliative Care in Aged Care (SPACE) project across Queensland.

Smith R, Merlo G, Broadbent AM, Lock C, Mickan S, Morgan N.

Abstract

There is an urgent and unmet need for specialist palliative care services in residential aged care. The Specialist Palliative Care in Aged Care (SPACE) Project aimed to improve palliative and end-of-life care for older people living in residential aged care facilities in Queensland. A representative working group developed a series of service principles around palliative care practice in aged care (comprehensive resident-focused care, streamlined service, and capacity building). Funding was allocated by population to the health services in Queensland to adapt and implement models of care aligned with these principles. SPACE successfully implemented a variety of decentralised models of care across Queensland. The critical elements for the success of SPACE were the use of an expert working group to define the core innovation, networking and implementation support from the central project team and community of practice, and adaptable models of care led by local facilitators. Lessons learned from this real-world case study could be adopted to guide and ensure the successful implementation and sustainability of future complex interventions in healthcare settings, both nationally and internationally.

12 March 2024

Palliative care utilisation and outcomes in patients admitted for heart failure in a Victorian healthcare service.

Ye S, Corbett C, Dennis ASM, Jape D, Patel H, Zentner D, Hopper I.

Abstract

Background: Heart failure (HF) has high mortality and healthcare utilisation. It has a complex and unpredictable trajectory, which is often interpreted as a barrier to guideline recommended early integration of palliative care (PC). In particular, lack of referral criteria and misconceptions around PC affect inpatient specialist PC referrals.

Aims: The main objective was to characterise the pattern and predictors of referral of HF patients to the specialist inpatient PC consultative service at our healthcare service.

Methods: A retrospective, single-centre cohort study was performed on consecutive patients admitted across the hospital with HF over a 12-month period (July 2019-June 2020). Mortality data were checked against state death registry data.

Results: The 502 patients admitted for HF were elderly (mean age 78±14 years), had high dependency (54% Australian-modified Karnofsky Performance Status (AKPS) 50-70, 29% AKPS 10-40), and high mortality (53% within median 32 months at death registry data linkage). Seven per cent (7%) were referred to inpatient specialist PC. AKPS 10-40 (62% of those referred vs 26% not referred, p<0.01), reliance on carers (65% vs 36%, p<0.01), and New York Heart Association (NYHA) class III-IV symptoms (86% vs 42%, p<0.01) were associated with referral, but two or more admissions in the last 12 months for HF were not (16% vs 10%, p=0.21). Many PC domains, such as symptom burden, distress, and preferred care, were not adequately assessed.

Conclusions: Referral to inpatient specialist PC in hospitalised HF patients is low relative to the morbidity and mortality in these patients.

Crown Copyright © 2024. Published by Elsevier B.V. All rights reserved.

12 March 2024

Professional bereavement photography for perinatal loss: A mixed-methods study.

Vivekananda K, McDowell C, Knipe K, McMaster C, Rahimi F, Richards M, Salvini S.

Abstract

This study addresses research gaps regarding the impact of professional bereavement photography for perinatal loss. Utilizing a mixed-methods research design, 504 parents completed an online survey measuring their attitudes toward bereavement photography and its impact. Thirty-one parents participated in semi-structured interviews. The results indicate a high level of acceptability and satisfaction for professional bereavement photography by parents (including those from more diverse backgrounds). Data triangulation confirmed that photos are valuable in enfranchising grief, validating parental and babies' identities and facilitating connections with others. Significant correlations were found for sharing of photos with both positive attitudes toward photography and for continuing bonds. The expression of continuing bonds in public social media spaces suggests increased social acceptance and validation for grieving perinatal losses. The findings from this study further inform practice guidelines for supporting perinatal loss.

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Last updated 16 January 2024